{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T10:48:12Z","timestamp":1789642092754,"version":"4.0.0"},"reference-count":20,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2017,12,20]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We aimed to analyse the incidence of prosthesis\u2013patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as \u226520\u2009mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta \u22120.023; 95%\u2009CI \u22120.032 to \u20130.014; P&lt;0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta \u22120.11; 95%\u2009CI \u22120.161 to \u20130.071; P&lt;0.001), higher BMI (unstandardised beta \u22120.01; 95%\u2009CI \u22120.013 to \u20130.007; P&lt;0.001) and implantation of a SAPIEN\/SAPIEN XT\/SAPIEN 3 transcatheter device (unstandardised beta \u22120.064; 95%\u2009CI \u22120.095 to \u20130.032; P&lt;0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2017-312422","type":"journal-article","created":{"date-parts":[[2018,1,19]],"date-time":"2018-01-19T12:15:25Z","timestamp":1516364125000},"page":"828-834","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":71,"title":["Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve"],"prefix":"10.1136","volume":"104","author":[{"given":"Sabine","family":"Bleiziffer","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"},{"name":"Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Erlebach","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"},{"name":"Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus","family":"Simonato","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, Escola Paulista de Medicina - UNIFESP, S\u00e3o Paulo, Brazil"},{"name":"Centre for Heart Valve Innovation, St. Paul\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Pibarot","sequence":"additional","affiliation":[{"name":"Department of Medicine, Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec, Quebec City, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Webb","sequence":"additional","affiliation":[{"name":"Centre for Heart Valve Innovation, St. Paul\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Capek","sequence":"additional","affiliation":[{"name":"University Hospital of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Windecker","sequence":"additional","affiliation":[{"name":"University Hospital of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"George","sequence":"additional","affiliation":[{"name":"Columbia University, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Malte","family":"Sinning","sequence":"additional","affiliation":[{"name":"University of Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Horlick","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre, University Health Network, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Napodano","sequence":"additional","affiliation":[{"name":"University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Holzhey","sequence":"additional","affiliation":[{"name":"University of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petur","family":"Petursson","sequence":"additional","affiliation":[{"name":"Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Cerillo","sequence":"additional","affiliation":[{"name":"Fondazione Toscana Gabriele Monasterio, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Bonaros","sequence":"additional","affiliation":[{"name":"Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Cardiocentro Ticino, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio G","family":"Cohen","sequence":"additional","affiliation":[{"name":"University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giselle","family":"Baquero","sequence":"additional","affiliation":[{"name":"University of Miami, Miami, Florida, USA"},{"name":"Southern Illinois University, Springfield, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara L","family":"Jones","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0080-1660","authenticated-orcid":false,"given":"Ankur","family":"Kalra","sequence":"additional","affiliation":[{"name":"Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA"},{"name":"Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Reardon","sequence":"additional","affiliation":[{"name":"Houston Methodist, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Chhatriwalla","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Mid America Heart Institute, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasco","family":"Gama Ribeiro","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Alnasser","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre, University Health Network, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas M","family":"Van Mieghem","sequence":"additional","affiliation":[{"name":"Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian J\u00f6rg","family":"Rustenbach","sequence":"additional","affiliation":[{"name":"Heartcenter, Department of Cardiovascular Surgery, University Hospital Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Schofer","sequence":"additional","affiliation":[{"name":"Albertinen Herzzentrum, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Garcia","sequence":"additional","affiliation":[{"name":"Minneapolis VA Healthcare System, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Zeus","sequence":"additional","affiliation":[{"name":"University Hospital Duesseldorf, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Champagnac","sequence":"additional","affiliation":[{"name":"Clinique du Tonkin, Villeurbanne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffi","family":"Bekeredjian","sequence":"additional","affiliation":[{"name":"University of Heidelberg, Heidelberg, 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Transcatheter replacement of failed bioprosthetic valves: Large multicenter assessment of the effect of implantation depth on hemodynamics after aortic valve-in-valve. 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